CBD for chronic pain: real benefits and expectations

CBD oils have become very popular among people looking to relieve pain naturally. But can CBD really be effective for chronic pain? This guide gathers, reviews and summarises the most up-to-date scientific evidence on CBD and chronic pain (up to 2026) to answer that question.

Note: this is an informational article and is not intended to prevent, diagnose or treat any disease. Its content may complement, but never replace, the diagnosis or treatment of a healthcare professional. Consult your doctor before using CBD, especially if you have any medical condition or take medication.

The 3 key takeaways:

• Isolated CBD has not been shown to outperform placebo for chronic pain; the strongest analgesic signal appears when it is combined with THC (prescription medical cannabis).
• Possibly, where CBD oils can help most is in improving the sleep, anxiety and tension associated with pain, with a favourable safety profile.
• If you decide to use CBD, consult a doctor specialised in chronic pain treatment and cannabinoid therapy first. Be especially cautious if you take medication, as interactions exist.

What is chronic pain?

Chronic pain is an unpleasant, persistent experience associated (actually or potentially) with damage to a body tissue, which persists over time beyond what would be expected for an acute injury.

Causes of chronic pain

The causes of chronic pain are diverse: autoimmune, vascular, neurological or oncological diseases, poorly healed fractures or specific health conditions. In addition, its intensity and experience vary greatly from one person to another depending on genetic, psychological and contextual factors.

Conventional treatment of chronic pain

Conventional treatment depends on the cause and the severity. Some options include painkillers (paracetamol, metamizole, opioids), anti-inflammatories (ibuprofen, naproxen), antidepressants such as amitriptyline or anxiolytics such as diazepam, as well as diet therapy, physiotherapy and psychotherapy.

It's worth understanding that it is a complex condition to manage: it can't be measured objectively with diagnostic tests, and addressing it requires personalised strategies. Listening to and trusting the person who suffers it is essential, because they are the one who can best describe it. That's why the approach should be multifactorial, combining different therapies to relieve pain and improve quality of life.

Does CBD work for chronic pain? What the scientific evidence says

What is CBD?

CBD or cannabidiol is one of the main cannabinoids in the hemp plant (Cannabis sativa L.). Unlike THC (tetrahydrocannabinol), it is not psychoactive. For more detail, see the differences between CBD and THC.

After a critical review of the evidence, the World Health Organization (WHO) concluded in 2018 that CBD is generally well tolerated, with a good safety profile, and that it shows no potential for abuse or dependence and no effects indicative of recreational use (1). This refers, however, to the safety of the compound, which is a separate matter from its therapeutic efficacy, as detailed below.

There's also a key nuance for pain: CBD does not act in isolation within the plant. It coexists with THC, with other minor cannabinoids and with terpenes, and a large part of the effect attributed to medical cannabis on pain comes from a combined action of several compounds, and not from CBD on its own —the hypothesis known as the entourage effect.

In fact, THC and CBD modulate pain through different pharmacological mechanisms and, according to the available clinical evidence, most of the plant's analgesic signal is attributed to THC, not CBD.

Is CBD effective for chronic pain?

The highest-level evidence is cautious: the major reviews and scientific societies note that the benefit of cannabinoids for pain is modest and may not outweigh their possible adverse effects, and that CBD without THC, at the doses of consumer products, has not been shown to improve pain or function compared with placebo (2, 3, 4, 5). Only at very high doses (medicinal, under professional supervision) has any signal begun to appear with CBD on its own, as we'll see below.

In human studies, the most consistent analgesic signal appears with THC or with THC+CBD combinations, and not with CBD on its own (without THC) (2, 4).

CBD maintains a favourable safety profile (1) and could offer indirect benefits on factors that accompany pain (sleep, anxiety, tension), which justifies the scientific interest and continued research, even though it doesn't yet allow us to conclude that isolated CBD has analgesic efficacy.

We cover these indirect benefits on sleep and anxiety in our guides to CBD for anxiety and CBD for sleep.

The role of THC and CBD in chronic pain (and the entourage effect)

There's an idea that comes up repeatedly in medical cannabis research: in pain treatment, the plant's two main cannabinoids don't play the same role.

THC and CBD act through different mechanisms, and the evidence suggests that THC plays a central role in the analgesic effect, while CBD contributes above all to tolerability and safety.

• THC accounts for most of the analgesic effect. It activates the CB1 receptor, which on its own produces analgesia; that's why, in the reviews, the (modest) relief signal appears with products that contain THC, and not with CBD alone (2, 4). In fact, the most studied drug in this field is nabiximols (Sativex®), a spray with a ratio close to 1:1 THC to CBD (about 2.7 mg of THC and 2.5 mg of CBD per spray); alongside it, THC in drug form (dronabinol, nabilone) and herbal medical cannabis (cannabis flower or buds), with variable THC content, have also been studied.
• CBD provides safety and tolerability. It can ease some of THC's effects (anxiety, rapid heartbeat) and maintains a good safety profile.
• The entourage effect. This is the hypothesis that the plant's compounds (cannabinoids and terpenes) work better together than separately; it has preclinical support, and the strongest recent clinical data was obtained with a THC-dominant full-spectrum extract (6).

As for using cannabis to enhance the opioid effect, that is, the idea that cannabis could allow opioid doses to be reduced, for now it has low-certainty controlled evidence and is not solidly confirmed (7, 8).

In addition, the therapeutic use of THC or CBD corresponds to prescription medical cannabis, not to an over-the-counter wellness product. In Spain and the EU, consumer products must stay below the legal THC limits.

Cannabinoids show modest efficacy that is not free of adverse effects. If the goal of a treatment is to address intense pain, it's advisable to consult a professional specialised in cannabinoid therapy, and the use of cannabis for medical purposes without professional supervision is not recommended.

In detail: scientific studies on CBD and pain: the latest research

Research on CBD and chronic pain has grown a great deal. Here's a summary, ordered from the strongest evidence to the weakest:

The major scientific reviews on CBD and pain (the strongest evidence)

These are the works that bring together and summarise all the available science (systematic reviews and meta-analyses), which is why they are the most reliable tier of evidence: the Cochrane review on neuropathic pain (2018, updated in 2025) (2, 23), the IASP position statement (2021) (3) and the AHRQ review, with evidence updated to 2025 (4).

They indicate that cannabis with THC shows a modest benefit for some types of pain, while CBD on its own has not been shown to outperform placebo. In the studies, when they talk about “cannabis” they almost always mean products with THC —the nabiximols spray ~1:1 THC:CBD, THC drugs or herbal cannabis—, not THC-free CBD oils. In fact, the Cochrane update (2025) is even more cautious than the 2018 one: after adding new trials, it found no clear evidence of meaningful relief for any of the three product types —THC-dominant, balanced THC:CBD or CBD-dominant—, with very low certainty of evidence (23).

Along the same lines, the report by the US National Academies (NASEM, 2017) acknowledged substantial evidence of the efficacy of cannabis —with THC— in chronic pain in adults (9).

The recent clinical trials (2024-2026)

Here is the latest research, and placing the studies side by side leaves a very clear lesson about the role of THC and of the dose:

• In favour (a THC-dominant product): in 2025, a phase 3 trial —the highest level of proof before a drug is approved— with a full-spectrum extract (VER-01, derived from a Cannabis sativa strain standardised to 5% THC) significantly improved chronic low back pain compared with placebo (6). The important nuance is that this extract is rich in THC and contains almost no CBD: each dose provides about 2.5 mg of THC and only 0.02 mg of CBD, and the daily dose reached around 32.5 mg of THC. In other words, what worked was, in practice, a THC product.
• Against (isolated CBD, without THC, at a low dose): also in 2025, a double-blind trial with an oil rich in CBD (45 mg a day) and practically without THC (below the detection limit) in knee osteoarthritis did not outperform placebo, although it was well tolerated (5). The authors themselves suggest that this absence of THC may have been one of the reasons it didn't work.
• CBD at high pharmacological doses: in 2026, a University of Sydney trial with CBD at 800 mg a day in neuropathic pain achieved a modest but significant improvement compared with placebo (24). It's a relevant result, but it's worth putting in context: it corresponds to a medicinal dose under professional supervision, far higher than that of any over-the-counter oil.

Overall, the available evidence links the analgesic effect mainly to products that contain THC (2, 4, 6), while CBD on its own has not consistently shown superiority over placebo (4, 5).

On the other hand, researching medical cannabis is especially complex because of legal restrictions, the limited standardisation of products and the difficulty of properly blinding trials (THC's effects give the treatment away), which limits the number and quality of the available studies. This largely explains why the evidence remains low. If you're considering the use of medical cannabis for chronic pain, it's advisable to see a professional specialised in chronic pain and cannabinoid therapy.

Animal studies and published case reports on CBD and pain

Most of the promising data come from animal models (where CBD relieved pain without building tolerance) and from isolated case reports. Two examples published in people: a single adolescent patient with sickle cell disease whose pain improved with CBD (but at very high, pharmaceutical-range doses) (10), and an open-label study in 20 athletes using CBD cream who improved their function (but with no placebo group) (11).

These are signals that justify further research, not proof of efficacy: with a single case or no placebo, you can't rule out the placebo effect, which is very powerful in pain.

In general, with the current data, there is growing scientific evidence and reasons for interest, but it still can't be claimed that isolated CBD works as a painkiller; the most recent positive evidence appears only at very high doses (24).

Which types of pain has CBD been studied for?

Most of these studies are preclinical (in animals or cells). They point to plausible mechanisms and motivate research, but they're not equivalent to proven efficacy in people.

CBD for neuropathic pain

This is the type of pain with the most favourable signal, especially with products that contain THC. In animals, CBD relieved neuropathic pain without building tolerance (12, 13), but in humans the evidence for isolated CBD is still insufficient. We look at it in detail in our guide to CBD and neuropathic pain.

CBD for inflammatory pain and osteoarthritis

CBD has shown anti-inflammatory properties in animal models —it reduces mediators such as IL-6 and TNF-α and, in osteoarthritis in dogs and rodents, improved pain and mobility (14, 15, 16)—, but the jump to humans doesn't confirm it: the most relevant placebo-controlled trial in knee osteoarthritis (2025) found no difference compared with placebo (5). Some studies with topical CBD (e.g. at the base of the thumb) are promising, but with a small sample size (17). For joint pain, we go into more detail in CBD for arthritis and joint pain.

An important nuance: the well-known autoimmune encephalitis study that is sometimes cited attributes the effect to THC, not CBD (18).

The endocannabinoid system and pain

To understand where CBD might act, it helps to know the body's network that helps regulate pain (the endocannabinoid system). It's a set of messengers and receptors spread throughout the body; its two main receptors are CB1 (mainly in the brain and nervous system) and CB2 (more in the immune system and peripheral tissues such as the gut or the skin).

This system is present along the entire path the pain signal travels (the nociceptive pathway): there are receptors both in the cells that detect damage (nociceptors) and in the neurons of the spinal cord and brain (19).

When there's an injury, cells release inflammatory substances and pain signals, and the endocannabinoid system is activated to help modulate that perception. The plant's two most studied cannabinoids —THC and CBD— can influence this process, but through very different mechanisms. If you want to go deeper, we explain it in endocannabinoid system.

How does CBD act in the body?

Unlike THC, CBD does not directly activate the body's classic cannabinoid receptors (CB1 and CB2). So where would the effect on pain seen in studies come from? Pharmacology describes CBD as acting through other pathways in the cell (20, 21):

• It calms inflammation by acting on receptors that regulate pain and temperature (vanilloid receptors: TRPV1, TRPV2 and TRPV3), and not through the classic cannabinoid receptors.
• It “switches off” the signal from the nerves' pain receptors: it does the opposite of activating them (what pharmacology calls being an inverse agonist of the GPR3, GPR6 and GPR12 receptors).
• It supports the body's natural analgesia system (the µ and delta opioid receptors), curbing the pain signal in the neuron and at the nerve endings.

In short, CBD doesn't achieve its effect by activating the typical cannabinoid receptors, but through several families of receptors involved in pain control. This fits with its good safety profile and its few side effects, even though —as we saw— it coexists with still-limited clinical evidence as a painkiller.

How is CBD used for pain?

The main routes are:

• Oral and sublingual: the same oil, swallowed or held under the tongue. Sublingual CBD is absorbed through the lining of the mouth and acts a little faster than swallowing it, while the oral route gives a more sustained effect. It's the usual option for a systemic, prolonged effect.
• Topical (creams or oil): for a specific area, low risk and reasonable to try as a local complement, with modest expectations.
• Inhaled (vaporising): CBD enters through the lungs, making it the route with the fastest effect (within minutes), though also the shortest; it's also the least studied for pain.

In all cases, it's worth remembering that these indications refer to products regulated for medicinal use. Over-the-counter CBD products are not intended to prevent, treat or cure diseases and are sold for external use in accordance with European law.

You can find more information in the guide on how to use CBD.

What dose of CBD for pain?

There's no standard dose: it depends on the person, the type of pain and the product's concentration, and it must be prescribed and supervised by a doctor.

We've gathered the studied ranges (low, moderate and high) and how many drops of CBD are usually used in a separate guide: CBD dosage for chronic pain.

CBD and interactions with medications

CBD interacts at the liver level with several drugs (antiepileptics, anticoagulants, etc.), so medical supervision is essential if you take medication: you can see CBD and medications.

With pain medications you should be especially careful, because they share liver metabolism with CBD:

• Paracetamol and NSAIDs (ibuprofen, naproxen): occasional use in healthy people doesn't seem problematic, but at high doses or with liver problems they can add hepatic load; besides, CBD has not been shown to enhance their analgesia.
• Metamizole (Nolotil®): the interaction would also be hepatic.
• Opioids (tramadol, codeine, morphine, fentanyl): you must take extra medical caution; some studies suggest a degree of effect potentiation.

We go into this product by product in CBD with paracetamol, Nolotil® and opioids: is it safe?.

In addition, chronic pain is often treated with drugs that aren't classic painkillers and that do have relevant interactions with CBD, such as antidepressants, anticonvulsants or anticoagulants. If you regularly take any of these, consult your doctor.

Safety and side effects of CBD

At consumer doses, CBD is generally well tolerated. The most common adverse effects are mild: drowsiness, digestive discomfort or tiredness. Serious problems (such as raised liver enzymes) are associated above all with very high, prolonged doses.

Most of CBD's relevant adverse effects come from its interaction with other drugs, potentially increasing their adverse effects, or raising or lowering their efficacy. We look at this in detail in side effects of CBD and toxicity.

Is it legal to use CBD for pain in Spain?

CBD for therapeutic use falls under the umbrella of medical cannabis, which contains THC in relevant proportions —from equal CBD:THC ratios to preparations with more THC than CBD, and generally with high THC content—, is dispensed by prescription and its regulation varies from country to country. We go into this in medical cannabis: uses and regulation in Europe.

Over-the-counter CBD products are not medicines or food supplements and are not regulated as such. That's why their efficacy differs from that of a medical treatment: to address pain with effective options, the right approach is a professional assessment and following the specialist doctor's guidance.

Frequently asked questions about CBD and chronic pain

Can CBD oil remove or improve chronic pain?

In general, with the current data, the best available evidence (AHRQ 2025, Cochrane and IASP) indicates that CBD on its own has not been shown to outperform placebo for chronic pain (2, 3, 4). An over-the-counter oil is precisely that —isolated CBD or “broad spectrum”, with almost no THC—, and the most consistent analgesic signal appears with THC or full-spectrum extracts with THC (6), which a legal consumer product doesn't provide in therapeutic amounts. In short, CBD can help indirectly (sleep, anxiety or tension associated with pain), with a supporting role rather than that of a potent painkiller.

Why do some people try CBD and notice no effect?

A very common cause is under-dosing. Clinical studies tend to use very high doses —for example, 600 mg a day in osteoarthritis (alongside paracetamol), and even above 1,500 mg/day in hospital settings—, whereas an over-the-counter oil usually provides on the order of 10-50 mg per dose. Those clinical doses are too high to take at home on your own: they only make sense under medical supervision, because of the risk of adverse effects and interactions.

Can CBD replace pain medications?

In chronic pain, self-medicating and delaying proper medical care is a risk. Always consult your doctor, or seek a second or third opinion on your treatment from doctors specialised in pain therapies or in cannabinoid therapy, and keep your treatment going unless told otherwise.

If I take CBD, do I have to worry about interactions with my medications?

Yes. CBD inhibits liver enzymes (the cytochrome CYP450 family) that metabolise many drugs. People with chronic pain often take several medications at once —anticoagulants (Sintrom/warfarin), antiepileptics, some antidepressants, opioids or benzodiazepines— and CBD can alter their blood levels (22). If you take medication chronically, it's essential to consult your doctor or pharmacist before starting.

What about CBD creams for a specific area (knee, back)?

For localised pain, a CBD cream or topical oil is low risk and reasonable to try as a local complement. That said, with modest expectations: the most relevant placebo-controlled trial (knee osteoarthritis, 2025) showed no superiority of CBD over placebo (5). It may provide local relief and a sense of comfort, but the robust evidence isn't there yet.

Is CBD safe? What side effects can it have?

At consumer doses, CBD is generally well tolerated. The most common effects are mild: drowsiness, digestive discomfort or tiredness. Serious problems (such as raised liver enzymes) are associated above all with very high, prolonged doses. Most of the relevant effects come from its interaction with other drugs (22), hence the importance of supervision if you take medication.

In summary, is using CBD for chronic pain recommended?

Over-the-counter CBD products are not medicines or food supplements. In this guide we've summarised the available data and the reasonable expectations based on the evidence, but individual experience can vary greatly from one person to another. As with any approach to pain, a professional assessment is needed: always consult your doctor before using CBD, especially if you have a diagnosed condition or take medication.

Disclaimer: this article is for informational purposes only and does not constitute medical advice. Cannactiva's CBD products are not medicines or food supplements and, in the European Union, are marketed for external use. The information gathered here may complement, but never replace, the diagnosis or treatment of a healthcare professional. Consult your doctor before using CBD, especially if you have a medical condition or take medication. Research on CBD is ongoing and new evidence may have emerged since the publication date.

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